Provider Demographics
NPI:1346437621
Name:CARROCA, DAVID (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:CARROCA
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 FORT GREENE PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1419
Mailing Address - Country:US
Mailing Address - Phone:347-853-2906
Mailing Address - Fax:718-858-5953
Practice Address - Street 1:136 FORT GREENE PL
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1419
Practice Address - Country:US
Practice Address - Phone:347-853-2906
Practice Address - Fax:718-858-5953
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist